Belatacept may reverse cognitive impairment in transplant recipients
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Transplant recipients who were converted from tacrolimus to belatacept showed improvements in various domains of cognition, suggesting this treatment change may help reverse cognitive impairment.
The study, which used the reportedly less expensive and less time-consuming NIH Toolbox Cognition Battery of tests instead of traditional neuropsychiatric assessments, was presented virtually at the American Transplant Congress.
“As we are all know, tacrolimus has many adverse effects,” William S. Asch, MD, PhD, associate professor of medicine and surgery at the Yale New Haven Transplantation Center, said. “Hypertension, tremor, alopecia and new onset diabetes are commonly reported by our patients, and we are ever concerned about the effects of calcineurin inhibitors [CNIs] with regard to their nephrotoxicity. Accelerated cardiovascular disease is also a significant long-term concern.”
According to Asch, cognitive impairment may also be a concern with calcineurin inhibitors, but it is likely underappreciated due to lack of accurate reporting from patients and challenges of studying the condition.
“Further, this cognitive impairment is potentially reversible,” he said.
With this in mind, Asch and colleagues assessed the impact of belatacept on the cognitive function of 20 transplant recipients who discontinued immunosuppression with tacrolimus. The cohort had a mean age of 52.5 years and had been on CNI therapy for a mean of 40.6 months.
Cognitive assessments were taken before conversion to belatacept and were retested 6 months later; 11 reported neurocognitive symptoms prior to conversion.
At 6 months, cognitive improvements were seen in scores for attention and executive function (raw score improvement of 7%), episodic memory (improvement of 9%), processing speed (improvement of 11%) and the cognition fluid composite (improvement of 9%).
“Our pilot study substantiates the patient-reported perception that cognitive function is mildly impaired on CNI and that improvement is possible following conversion to belatacept” Asch concluded. “Our study also confirms that neurocognitive testing can be performed by transplant clinicians in the clinic setting using this testing platform.”
Testing takes less than an hour to complete, according to Asch, and the results can easily be exported with an ipad.
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Asch WS, et al. Kidney: Cardiovascular and metabolic complications. Presented at: American Transplant Congress; June 4 - June 9, 2021. (virtual meeting).
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